vicissitudes under which homosexual manifestations take place. The homosexual is not alone in taking only a member of his own sex as object choice. We all have homosexual object choices which indeed most of us satisfy in so-called sublimated ways. Our pursuits with pals, our most intimate intellectual and social friendships, our armin-arm singing at the piano after a few beers, our sports activities-all have in the broad sense some sort of homosexual connotations. These we value and enjoy without guilt or shame. No one is so masculine as not to expect some friendship or tender affection from a member of his sex. These things stem from our early childhood sexual wishessexual in the widest meaning-from the emotional life so intimately connected with our physical beings and the spiritual aspects of love. This point needs emphasis because of too much palaver about spiritual expressions of love as somehow being unconnected with our biological history.

Besides the mild and socially acceptable expressions of sublimated homosexuality, many other manifestations appear. Although not particularly abnormal or peculiar in the course of ordinary masculine activity, they yet indicate how protean are the forms and relics of homosexual wishes. For example, many a man is more potent and has a much more satisfactory heterosexual relationship after "a night out with the boys." Many a man, often without realizing it, feels keener, more intense interest in the woman's sexual experience than his own. Indeed his partner's frigidity may cause him much frustration in his sexual life not only because he feels he is not proving himself a man but also because she does not let him share in feminine pleasures. Many men secretly envy women's creating and nurturing qualities and activities. Fortunately, the social trend now makes acceptable such masculine envy of women; the tables turn and we hear much less about feminine envy of men. The line is hard to draw between these normal manifestations of homosexuality and near-pathological activities. Surely a patient addicted to prostatic massage satisfies some homosexual needs that may bear scrunity under a psychological microscope. Likewise a physician who unwittingly plays partner to this game may well scrutinize his role.

Such psychological attitudes clearly show that psychologically we are not wholly one sex or the other. Our deeper understanding of homosexuality has also affected our nosological concepts of mental illness. For instance, often homosexuality, as such, harms a person Mess than does the fear of homosexuality. Many homosexual conflicts that bring a patient to a physician or psychiatrist for the first time have little to do with homosexuality. The patient really fears some dissolution of his psychic apparatus or of his integrity as a person, and he picks on homosexuality as a first sign of dissolution. Many schizophrenic breaks first began with fears of homosexuality; that is, the concern about homosexuality is symptomatic, just as alcoholism is symptomatic of a much more important underlying emotional illness.

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TREATMENT

Very little is known about therapy of homosexuality. Just as the extent of homosexuality is greater than commonly believed, so the recoveries from distressing homosexual conflicts are probably more thar we think. Doubtless a good many persons through experience, kindness, tenderness and understanding are helped to get over their difficulties in ways we can now only speculate about. Many a homosexual person embarks upon heterosexual experience or even marriage in the attempt to cure himself and sometimes he is successful. Clinicians do not see these successes, but rather the failures of such heroic attempts. Sometimes hormonal treatment is successful. I get the impression in review of such "successes," that psychological, sug" gestive factors have had more importance than the chemical ones, and that no real cure has resulted.

Psychological treatment does not offer a much brighter picture. Homosexuality as such can hardly be treated because treatment of the underlying emotional disturbance is the essential thing. If homosexuality is touched, all to the good; if not, treatment can often enable the patient to accept his condition with more grace and ease, with less shame and guilt, so that he tends to get into less trouble than before. With some gain in clinical knowledge, satisfactory cures by psychiatric and especially by psychoanalytic treatment have slowly increased, but as yet the number is very small. Treatment is long and most difficult, and the course of a successful treatment very hard to report and explain.

To understand part of the difficulty, take one analogy: It is in general just as hard to change a homosexual's object choice as it would be to change a heterosexual into a homosexual. A case in point is that of a man prominent in public life, who consulted a well known psychoanalyst, saying bluntly: "I'm a homosexual with many compulsions and obsessions. I can't pass a gate without wanting to run my fingers or cane along the pickets. I have to go back ter times to make sure I've locked the door. I have to count to a cer+ tain number before starting any undertaking. I feel perfectly comfortable with my homosexuality. I have many agreeable compan ions who share my views. But my compulsions interfere with my life and I would like treatment for them without touching the homosexuality. Will you treat me under these conditions?"

The analyst replied that because homosexuality is. so extremely difficult to cure they could undertake treatment, with the patient's understanding how small the chance for such outcome. The man entered treatment and at the end of two years he was cured of homosexuality. He married happily and had two children. But, alas, ail his compulsions and obsessions remained intact and untouched. THE GENERAL PHYSICIAN AND THE HOMOSEXUAL PATIENT The general physician in his role with homosexual patients had best restrict his activities to what may be called minor psychiatry To practice it, he must form his attitudes from some understanding of medical psychology and not from the statute books. He or anyone 19